Why we compared the level of provision of specialist palliative care services in Scotland with European benchmarks

Our latest study on the provision of palliative care in Scotland has a focus on the delivery of specialist services.

We recognise of course that much palliative care is also delivered in non-specialist settings: in general practices, across hospitals, in care homes, and in the community. A big driver within the Scottish Government’s 2015 Strategic Framework for Action on Palliative and End of Life Care is to raise the level of that generalist palliative care so it is of better quality and it reaches more people.

But there will continue to be a role for specialist services. These are the services that deal with the most complex and challenging situations and cases. They are also the places where a lot of learning and teaching, research and knowledge exchange take place. So there is a continued role for these specialist services.

We wanted to know just how well we doing in the provision of specialist palliative care in Scotland.

Now in the context of Brexit, it was tempting to frame this question in relation to the countries of the European Union. Using the data contained within our 2016 Scottish Atlas of Palliative Care, we were able to ‘fit’ Scotland into a benchmarking model that had already been established for European countries by our colleagues in the Atlantes Project at the University of Navarra .

The model idenitifies three types of specialist palliative care provision: 1) inpatient units, mainly free-standing hospices, but services sometimes located in hospitals 2) the provision of hospital support teams working across entire hospitals to deliver palliative care where it’s needed 3) the provision of home care teams delivering palliative care to people in their own places of residence.

On each of these three dimensions we found that Scotland is in the top 10 of EU countries, as measured both by volume of services per milion population and in relation to guidelines published by the European Association for Palliative Care.

Scotland is in the top 10 countries in Europe for levels of palliativecare, according to research, published in BMJ #palliative care

If you look at our hospital support teams, we have exactly the level of provision that the European Association for Palliative Care recommends (100%). But Scotland is below the optimal on specialist palliative care inpatient units (85%) and home care teams (72%). So in relaiton to home care there is room for quite significant improvement by further investment and attention to what we know the Scottish Government is very committed to, which is care for people in their own places of residence.

There are some countries that for some types of service have a figure above 100% – so in a sense they’re ‘overproviding’ certain types of services against the European guideline. Scotland doesn’t overprovide anything, it’s providing at a high level that gets it into the top 10 countries on every one of the three categories we looked at. But in two cases it’s below the optimal level, and particularly so on the home care teams.

So what are the implications? I wouldn’t expect inpatient units to increase in number. We would hope to see more emphasis on home care teams and to see Scotland’s level of provision getting above 72% of the recommended guideline and closer to 100%, where it already sits with the hospital support teams.

The Scottish Government is making its way through the commitments in its Strategic Framework for Action on the delivery of palliative and end of life care. The data for our study were collected at the beginning of that process and so we believe this study could be a useful benchmark or baseline from which we can measure progress on the Strategic Framework over the five to seven years of its lifespan.

The findings of our paper have been published in a highly respected journal which is part of the BMJ family of journals, and our method has been subjected to critical review by external experts. We’re confident we could repeat the study on a periodic basis. That would not only allow us to see how Scotland is changing in relation to the European countries but also to see how it is faring in terms of progress against the stated aims of the Strategic Framework.

The work has been a great team effort. Led by Hamilton Inbadas in our group, it also involved Jose Miguel Carrasco from Spain and Michelle Gillies of the Scottish Public Health Network. It would not have been posisble without the funding we received from Scottish Government for the original work on the Atlas. On the day of publication, and encouraged by our Scottish palliative care colleagues, the work of Catriona Forrest ensured that the paper received a huge amount of social and print media attention, not only in Scotland, but around the world.

We will continue with such work, identifying at a population level how the provision of palliative care in Scotland is being delivered, and looking always to assist policy makers and providers with information that can aid their efforts for development and improvement.

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David Clark

David Clark holds a Wellcome Trust Investigator Award and leads the Global Interventions at the End of Life research project. He is Professor of Medical Sociology at the University of Glasgow and founder of the Glasgow End of Life Studies Group.
Follow David on Twitter @dumfriesshire
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